Psychiatry International

Suicidal behavior includes completed suicides and suicide attempts, which reflect different risk profiles and require joint analysis. In the Republic of Kazakhstan, recent data that simultaneously assess temporal trends, regional heterogeneity, and the probability of a fatal outcome remain limited. This study aimed to comprehensively assess the dynamics of completed suicides and suicide attempts in the Republic of Kazakhstan in 2023–2024, describe regional and age differences, and identify factors associated with a higher likelihood of completed suicide versus an attempt. A nationwide retrospective population-based observational study was conducted using anonymized officially registered data on suicidal behavior in Kazakhstan for 2023–2024. All registered episodes were included (n = 15,478), including completed suicides (n = 7102) and attempts (n = 8376). Age strata were 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74, and 75+. Rates per 100,000 population, the attempt-to-completed ratio, and the proportion of completed suicides among all episodes were calculated. Associations were assessed using odds ratios (ORs) with 95% confidence intervals (reference group: 15–24 years) and the Cochran–Armitage χ² test for trend (p < 0.05). In 2024 versus 2023, the number of completed suicides decreased from 3694 to 3408 (−7.7%), and attempts from 4340 to 4036 (−7.0%). Among minors, completed cases decreased (−14.2%), while attempts increased (+20.5%). The completed suicide rate declined from 18.6 to 17.2 per 100,000, and the attempt rate from 21.9 to 20.4 per 100,000. Across regions in 2024, completed suicide rates ranged from 11.7 to 28.8 per 100,000, attempt rates from 5.0 to 46.5 per 100,000, and the attempt-to-completed ratio from 0.3 to 3.6. Age showed a stable lethality gradient, with the proportion of completed suicides among all episodes increasing from 26.4% (15–24) to 67.7% (75+). The risk of completed suicide versus an attempt was highest in the 75+ group (OR = 5.86; 95% CI 5.15–6.67; p < 0.001) and increased sharply after age 45. In 2024, the likelihood of a fatal outcome was significantly higher for episodes with unestablished circumstances (OR = 2.29; 95% CI 2.08–2.52; p < 0.001) and severe somatic diseases (OR = 2.64; 95% CI 1.91–3.65; p < 0.001), whereas family/relationship conflicts were more common among attempts (e.g., conflict with parents OR = 0.12; 95% CI 0.06–0.21; p < 0.001). Similar patterns were observed in 2023 (unestablished circumstances OR = 1.92; severe somatic diseases OR = 2.22; conflict with parents OR = 0.17; all p < 0.001). In 2023–2024, Kazakhstan showed a decline in registered completed suicides and attempts; however, the structure of suicidal behavior is becoming more complex. Attempts among minors are increasing, high regional heterogeneity persists, and there is a pronounced age-related increase in the probability of a fatal outcome, especially after age 45. Prevention priorities should include targeted measures for older age groups and patients with severe somatic pathology, strengthening programs for early identification and support of minors, and improving the quality of registration and interagency analysis of the circumstances of fatal outcomes. Full article

The rapid expansion of digital technologies has created an unprecedented level of increased connectivity, yet the neurobiological mechanisms underlying these changes remain incompletely understood. This systematic review synthesizes the currently available evidence on neurobiological findings related to problematic internet use, problematic smartphone/social media use, and internet gaming disorder, with a focus on reward processing, attentional control, and emotional regulation. Across the included studies, recurrent findings suggested the involvement of fronto-striatal circuitry, salience- and reward-related regions, and executive-control networks. Alterations in large-scale brain networks, including the default mode, salience, and frontoparietal systems, were also reported, although the evidence base was heterogeneous and consisted largely of cross-sectional studies with modest sample sizes. Overall, the findings support a provisional neurobiological framework linking reward-related processing, inhibitory-control difficulties, and large-scale network alterations, but better-standardized studies are needed to draw conclusions. Full article

Coronavirus anxiety is defined as a psychological contrast characterized by excessive fear, obsessive thoughts, and reassurance-seeking behaviors associated with COVID-19. As current scales have been tested primarily in North American populations, we aimed to translate and culturally adapt three measures of dysfunctional coronavirus anxiety—the Coronavirus Anxiety Scale (CAS), the Obsession with COVID-19 Scale (OCS), and the Coronavirus Reassurance-Seeking Behaviors Scale (CRBS)—for the first time in Greek-speaking populations. To translate existing scales, we followed best practices for cross-cultural comparisons using forward translation (English to Greek) and backward translation (Greek to English) with expert translation review, prior to conducting pilot testing and confirmatory factor analysis in a bespoke survey population. A total of 405 adults from Cyprus participated in this study. The results indicated that the Greek versions of these measures demonstrated adequate reliability (Cronbach’s alphas > 0.70) and strong factor structure, as supported through confirmatory factor analysis. However, only the CAS exhibited evidence of both convergent and divergent validity. Our study makes several innovative contributions which have broad implications for crisis preparedness, including providing a framework for mental health interventions in future pandemics or Black Swan events. Full article

Coal mining is a hazardous occupation that can adversely affect both the physical and mental health of workers. This study aimed to estimate the pooled prevalence of various mental health outcomes and job burnout among coal miners and to summarize available intervention strategies addressing these conditions. A systematic search of scientific databases, including Scopus, Embase, PubMed and Cochrane Central, was conducted for studies published from 2000 onwards. The study protocol was registered in PROSPERO [CRD42024536144]. Methodological quality of the studies was evaluated using AXIS, ROBINS-I and RoB 2 tools. A random-effects model was applied to estimate pooled prevalences. Of the 14,048 studies identified, 34 studies were included, comprising a total of 38,996 coal miners. The pooled prevalence of job burnout was 53.75% (95% CI: 50.64–56.86%), while depressive symptoms were observed in 35.35% of coal miners (95% CI: 16.43–54.28%; I² = 97.41%). The pooled prevalence estimates were calculated with substantial heterogeneity (I² > 90%) and wide prediction intervals indicate considerable variability across studies. These findings should be interpreted with caution due to substantial heterogeneity across studies, which may limit the reliability of pooled estimates. A limited number of studies reported interventions, including an Integrated Approach of Yoga Therapy (IAYT) and peer-based mental health and suicide prevention programs with supervisor training, which demonstrated potential benefits; however, these findings are based on limited and methodologically heterogeneous evidence, and the overall certainty remains low. The findings highlight a substantial burden of mental health problems among coal miners and suggest important policy implications, particularly for integrating mental health screening into periodic occupational health assessments. Addressing personal, social, and work-related determinants through comprehensive workplace strategies may help improve mental well-being and support workforce sustainability in the mining sector. Full article

Background: Anorexia nervosa (AN) commonly emerges during adolescence and disproportionately affects girls. In recent years, problematic social media use (PSMU) has been identified as a potential sociocultural risk factor for eating disorder symptoms; however, the psychosocial pathways linking PSMU to AN symptomatology remain insufficiently understood. This study examined the associations between PSMU and AN symptoms in adolescent girls and explored the roles of perceived parenting style and childhood traumatic experiences as explanatory pathways. Methods: A cross-sectional, school-based survey was conducted with 463 adolescent girls aged 13–18 years in İstanbul, Türkiye. Participants completed validated self-report measures assessing AN symptoms (Eating Attitudes Test–26), problematic social media use (Social Media Disorder Scale), perceived parenting style (Parenting Styles and Dimensions Questionnaire), and childhood trauma (Childhood Trauma Questionnaire). Structural equation modeling was used to examine direct and indirect associations between PSMU and AN symptoms, controlling for age, body mass index, and socioeconomic indicators. Indirect effects were tested using bias-corrected bootstrapping. Results: Problematic social media use was directly associated with greater AN symptom severity (β = 0.18, p < 0.001). Significant indirect associations were also observed via perceived parenting style (β = 0.06, 95% CI [0.03, 0.11]) and childhood traumatic experiences (β = 0.07, 95% CI [0.04, 0.12]). Childhood trauma accounted for a larger proportion of the indirect association, while parenting style contributed a smaller but significant pathway. When both pathways were included simultaneously, the direct association between PSMU and AN symptoms remained significant, indicating partial mediation. Model fit indices indicated good overall fit. Conclusions: Problematic social media use is meaningfully associated with anorexia nervosa symptoms among adolescent girls, both directly and through indirect pathways involving parenting context and childhood trauma. Childhood trauma may be interpreted as a variable showing a significant indirect statistical association with both problematic social media use and anorexia nervosa symptoms, rather than a causal determinant within the present design. These findings underscore the importance of integrated, trauma-informed and family-sensitive prevention strategies that address adolescents’ digital environments alongside broader psychosocial vulnerabilities. Full article

Pediatric psychiatric emergency department (ED) visits have increased globally, yet many children do not receive timely outpatient follow-up. Although South Korea provides universal health coverage through its National Health Insurance (NHI), additional financial barriers may impede the continuity of mental health care. This study examined whether supplemental private insurance is associated with improved outpatient mental health follow-up after pediatric psychiatric ED visits within a universal coverage system. A retrospective cohort study was conducted at a tertiary children’s hospital in South Korea including 520 psychiatric ED visits (480 unique patients aged <18 years) from 2016 to 2024. The primary outcome was attendance at an outpatient mental health visit within 30 days of ED discharge. Multivariable logistic regression was used to assess the association between insurance type (NHI-only versus NHI plus supplemental private insurance) and follow-up, adjusting for age, sex, clinical presentation, and prior mental health care. Overall, 53.7% of patients attended a 30-day follow-up visit. Patients with supplemental private insurance had significantly higher follow-up rates than those with NHI alone (58.8% vs. 45.5%, p = 0.019). In adjusted analysis, supplemental private insurance was independently associated with increased follow-up (adjusted odds ratio 1.50, 95% confidence interval 1.10–2.05, p = 0.02). A significant interaction was observed between insurance type and prior mental health care (p_interaction = 0.03): the insurance effect was pronounced among patients without prior outpatient mental health treatment (45.6% vs. 38.8%) but negligible among those with prior treatment (71.9% vs. 72.5%). Prior outpatient mental health treatment (adjusted odds ratio 2.00, 95% confidence interval 1.30–3.10) and suicidal presentation were also significant predictors. Even within a universal health coverage system, supplemental private insurance is associated with better outpatient follow-up after pediatric psychiatric emergencies, particularly among patients new to the mental health system. Reducing financial barriers, expanding community-based mental health services, and strengthening care coordination are essential to ensure equitable continuity of care for all children. Full article

Background: This study aims to synthesise available evidence on positive psychology interventions for enhancing resilience among university students, based on randomised controlled trials (RCTs). Methods: A comprehensive search was conducted in Scopus, CINAHL, PsycINFO, and PubMed from the inception of positive psychology interventions until July 2025. The search terms included “PPI” or “positive psychology intervention” and “resilience” or “psychological resilience”; “university students”, “freshmen”, “higher education students”, “adolescents”, or “adolescent” or “teenagers”; and “resilience training”, “resilience enhancement”, or “positive psychology intervention (PPI)” and “resilience reinforcement”. The Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 guidelines were followed for conducting and reporting this review. Results: The systematic search identified 2346 records. After the removal of duplicates and the screening of titles and abstracts, 32 full-text articles were assessed for eligibility, and four RCTs were included in the final analysis. The risk of bias was analysed for the studies using RoB-2 for Cochrane reviews, and studies deemed to be at high risk of bias were excluded from the final review. Overall, all included studies demonstrated an improvement in resilience scores in the intervention group compared to those in the control group. In this review, Cohen’s d was calculated to standardise the mean differences across the studies, even when their outcome measures differed. Conclusions: This review suggests that resilience interventions could enhance resilience and associated psychological constructs, providing preliminary guidelines for developing and implementing resilience enhancement interventions for university students. The review protocol is registered under PROSPERO with the ID CRD420251138034. Full article

(1) Background: Social media addiction (SMA) is conceptualized as a behavioral addiction linked to emotional dysregulation. This study investigates whether multidimensional state boredom mediates the relationship between the quest for significance and SMA, exploring the moderating role of age cohorts. (2) Methods: A cross-sectional study was conducted with 316 Spanish participants (aged 18–68) divided into Generation Z, Millennials, and Generation X. Standardized measures (BSMAS, SQS, MSBS) were analyzed using a multiple moderated mediation model (PROCESS Model 14), controlling for gender. (3) Results: Boredom dimensions correlated positively with both quest for significance and SMA. The final model explained 53.5% of SMA variance. High-arousal boredom and inattention were positively associated with SMA, while low-arousal boredom showed a negative association. Notably, the quest for significance was indirectly associated with SMA through high-arousal boredom exclusively among Generation Z, with no significant indirect effects found in older cohorts. (4) Conclusions: The findings highlight high-arousal boredom as a key link between existential motives and SMA, particularly in younger individuals. These results underscore the importance of age-specific emotional and motivational processes in designing prevention and intervention strategies for problematic social media use. Full article

Suicide is commonly approached through clinical and psychological frameworks centred on the individual, alongside social explanations emphasising collective conditions. These perspectives offer complementary leverage for understanding and preventing suicidal behaviour. Between these levels, a clinically decisive segment can be specified with greater precision for psychiatric practice, namely the processes through which suffering becomes speakable, socially legitimate and clinically actionable, or is displaced into self-censorship, isolation and delayed help-seeking. This paper advances a service-facing biosemiotic model of suicide risk that formalises this segment as a communicative infrastructure and links it to the public circulation of suicide narratives across media and digital environments. The model comprises two coupled modules. The first, the communicative-classification module, characterises labelling and delegitimation operations that allocate epistemic credibility to crisis talk, foster self-stigma and increase the social cost of disclosing suffering. The second, the public-feedback module, specifies how media representation and repetition regulate the symbolic availability of narrative scripts, with closure- and openness-oriented configurations positioned along the Werther–Papageno continuum. Coupling the modules yields testable propositions concerning mediation via anticipated sanction and moderation by stigma and speakability and identifies conditions under which protective content may show limited translation into help-seeking behaviour. Implications are outlined for how the model may inform therapeutic risk assessment, continuity of care, and prevention. These implications are framed as hypotheses and implementation-relevant considerations derived from the model, with emphasis on (i) operationalising speakability as a clinically evaluable dimension, (ii) identifying institutional conditions that may reduce the communicative cost of help-seeking, and (iii) aligning public communication strategies with international reporting standards. The model is intended to support future empirical testing rather than to establish effectiveness at this stage. Full article

Background: Data on early changes in body composition during acute-phase treatment in adolescents with major depressive disorder (MDD) remain limited. In particular, the utility of novel anthropometric indices reflecting central and visceral adiposity has not been explored in this population. This study therefore aimed to examine short-term clinical outcomes alongside detailed anthropometric measures in drug-naïve adolescent inpatients receiving fluoxetine-based pharmacotherapy. Methods: Prospective, clinician-directed, non-randomized inpatient study. Drug-naïve adolescents with severe MDD (n = 23) received fluoxetine 20 mg/day, with some patients additionally receiving low-dose quetiapine (100 mg/day) based on clinical indication for six weeks. Depressive symptomatology was evaluated by questionnaires Montgomery–Åsberg Depression Rating Scale (MADRS) and Children’s Depression Inventory (CDI). Conventional and novel anthropometric indices (BMI, WHtR; BRI, AVI, ABSI, BAI) were examined using the objective bioimpedance-derived method for body composition. Results: Depressive symptom severity decreased over the six-week treatment period, with significant improvements observed on both MADRS and CDI (time effect p < 0.001). Response and remission rates increased over time in the overall sample. No statistically significant changes were observed in conventional or novel anthropometric indices across the study period. Conclusions: In this prospective pilot cohort of adolescent inpatients with MDD, six weeks of fluoxetine-based pharmacotherapy was associated with improvement in depressive symptoms. No short-term changes were observed in anthropometric indices; however, given the small sample size and limited follow-up, these findings should be interpreted cautiously and cannot be considered definitive evidence of cardiometabolic safety. Full article

Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently associated with working-memory (WM) weaknesses that affect learning and everyday functioning. This systematic review examined the extent to which technology-delivered interventions improve WM in children and adolescents with ADHD, with primary emphasis on standardized objective WM outcomes and secondary consideration of rating-based or in-app measures. Following PRISMA 2020 guidelines, we searched PubMed, PsycINFO, Web of Science, Scopus, ERIC, and IEEE Xplore and identified 22 eligible studies spanning PC-based training, mobile interventions, AI-adaptive programs, wearables, and neurofeedback. Across modalities, the clearest near-transfer signal emerged from process-specific PC-based interventions and some AI-adaptive programs evaluated with standardized objective WM tests. Mobile and neurofeedback approaches appeared promising in some studies, but the evidence was more heterogeneous and was more often supported by ratings, in-app composites, or less rigorous designs. Overall, current evidence suggests that technology-assisted WM interventions are most promising when they are process-specific, adaptive, and delivered at a sufficient dose, although conclusions remain constrained by heterogeneity in study design, outcome type, and methodological rigor. Full article

Background: The immediate postpartum period is a critical window for maternal mental health, with many women experiencing transient depressive disturbances that can predispose them to perinatal depression. Protective factors such as social support and religiosity may mitigate these depressive symptoms, yet their combined role in the early days after childbirth remains insufficiently explored. This study aimed to assess the relationship between perceived social support, religiosity, and postpartum blues during the first three days postpartum. Methods: A cross-sectional study was conducted with 294 postpartum women (mean age 30.2 ± 5.02 years) at the University Hospital Centre Osijek, Croatia. Participants completed the Edinburgh Postnatal Depression Scale (EPDS), Religiosity Scale (RS), and Social Support Scale (SSS). Nonparametric tests, correlation analyses, and linear regression were used to identify predictors of postpartum blues. Results: Depressive disturbances (EPDS > 10) were observed in 28.2% of participants, while 8.2% had scores suggestive of clinically significant depression. Higher perceived social support correlated with lower EPDS scores (ρ = −0.130, p < 0.05). Religiosity showed modest inverse associations with depressive symptoms. Caesarean section was associated with higher EPDS scores compared to vaginal delivery (p = 0.029). Conclusions: Social support and religiosity appear to be protective factors against depressive disturbances in the early postpartum period. Early screening and culturally sensitive interventions that integrate psychosocial and spiritual dimensions may promote maternal mental well-being. Full article

Background: Inadequate management of emotional responses, limited access to emotion regulation strategies, and difficulties in emotion regulation may co-occur with alexithymic traits and interoceptive inaccuracy or confusion. These dimensions may influence lifetime eating disorder spectrum manifestations. Objective: To assess, in a general population sample without Axis I psychiatric disorders, alexithymic traits, interoceptive confusion/inaccuracy, and difficulties in emotion regulation, and to explore their associations with eating disorder spectrum manifestations. Method: In this cross-sectional observational study, fifty-two participants aged 18–30 years, recruited via a university bulletin board, were assessed online using the Toronto Alexithymia Scale (TAS-20), Interoceptive Accuracy Scale (IAS), Interoceptive Confusion Questionnaire (ICQ), Eating Attitude Test (EAT-26), and Difficulties in Emotion Regulation Scale (DERS) (protocol #01/2025). Results: Interoceptive confusion (ICQ) showed significant positive correlations with TAS-20, DERS, and EAT-26 total scores. ICQ scores were associated with TAS-20 subscales ‘difficulty identifying feelings’ (DIF) and ‘difficulty describing feelings’ (DDF). Participants with TAS-20 scores > 51 (n = 35; 67.3%) had significantly higher EAT-26 scores on ‘dieting’ (p = 0.043) and ‘bulimia’ (p = 0.017), as well as higher ICQ (p = 0.001) and DERS (p = 0.001) total scores, with smaller differences in the DERS ‘impulse’ subscale (p = 0.037). Conclusions: Preliminary findings suggest a pattern of co-occurring traits characterized by alexithymia, interoceptive confusion, emotional dysregulation, impulsivity, and eating disorder spectrum features, supporting the study hypothesis. Full article

Although recent studies report elevated rates of post-traumatic stress disorder (PTSD) among Ukrainian refugees, data from military hospitals and rehabilitation centers within Ukraine remain scarce. Numerous studies have described that interactions with therapy dogs help mitigate PTSD symptoms by providing emotional support, reducing hypervigilance, encouraging social engagement, and facilitating physiological de-arousal. However, the potential role of dog-assisted interventions (DAIs) in therapeutic settings during ongoing conflict has not yet been investigated. In this study, saliva samples pre- and post- a 20 min DAI were gathered from soldiers and other military service personnel with diagnosed PTSD in Kyiv, Ukraine. Salivary cortisol was assessed as a biomarker to parallel acute physiological strain. The findings revealed a decrease in salivary cortisol from pre- to post-DAIs in both men and women. Of note, men exhibited higher salivary cortisol levels than women both pre- and post-DAIs. The present findings suggest that people with PTSD benefit from canine support due to reduced acute arousal in a war environment. Limitations include the small sample size and the lack of a control group. In order to mitigate against the high prevalence of psychophysiological distress in at-risk populations such as military personnel, further research is warranted. Full article

Background: Emotional awareness is a core component of professional competence in healthcare, influencing therapeutic communication, stress regulation, and relational effectiveness. Alexithymia, defined as difficulty identifying and describing emotions, may interfere with the development of these skills during nursing education. Objective: This study aimed to evaluate the prevalence of alexithymic traits in Italian nursing students and to examine differences according to gender and academic year. Methods: A multicenter cross-sectional design was adopted. A total of 232 undergraduate nursing students from several Italian universities completed the Toronto Alexithymia Scale (TAS-20) via an anonymous online survey. Descriptive statistics, independent samples t-tests, and one-way ANOVA were performed. Results: The mean TAS-20 total score was 60.36 (SD = 11.22), approaching the clinical cutoff. Approximately 26% of students met the criteria for alexithymia. No statistically significant differences emerged across gender or academic year. A near-significant trend was observed for the Difficulty Identifying Feelings subscale (p = 0.053). Conclusions: A substantial proportion of nursing students reported elevated alexithymic traits. These findings highlight the need to strengthen emotional competence within nursing curricula to support professional development and resilience. Full article

Background: Previous research has suggested a potential association between low serum cholesterol levels and aggressive or violent behavior; however, findings across studies have been inconsistent, and meta-analytic evidence remains limited. Objectives: To meta-analyze the association between serum cholesterol levels and aggression, and to examine whether study design, population characteristics, and biological sex moderate this relationship. Methods: A meta-analysis of peer-reviewed English-language studies was conducted. Web of Science, APA PsycInfo, APA PsycArticles, PubMed, and Ovid Medline were searched up to September 2025. Eligible studies examined the relationship between serum cholesterol and aggression using either experimental–control group designs or one-group correlational designs. Risk of bias was assessed indirectly through study design characteristics and heterogeneity analyses. Random-effects meta-analyses with restricted maximum likelihood estimation were performed separately for each design type. Results: Twenty-nine studies comprising 6285 participants were included. In experimental–control group studies (15 comparisons; n = 3345), lower cholesterol levels were significantly associated with higher aggression (b = −0.56, SE = 0.15, p = 0.002), although heterogeneity was substantial (I² = 91.0%). In contrast, one-group correlational studies (17 samples; n = 2940) showed no significant association between cholesterol and aggression (b = 0.07, SE = 0.05, p = 0.160; I² = 90.8%). Differences in psychiatric status and sex distribution between study designs were pronounced and may partially explain discrepant findings. Limitations: The evidence base was characterized by high heterogeneity, variable operationalizations of aggression, and a predominance of older studies. Risk of bias could not be formally assessed using standardized tools. Conclusions: This meta-analysis indicates that lower cholesterol levels are associated with increased aggression primarily in studies comparing aggressive and non-aggressive groups, particularly within psychiatric populations. The absence of this association in correlational studies suggests that population characteristics, measurement methods, and sex distribution critically influence observed effects. Future research should clarify underlying biological mechanisms and address methodological heterogeneity. Full article

Background: Problematic smartphone use has been increasingly reported among university students, including nursing students, yet the availability of brief, culturally appropriate, and psychometrically sound assessment instruments in Greece remains limited. Aim: This study aimed to translate and culturally adapt the Greek version of the Smartphone Addiction Scale—Short Version (SAS-SV) and to evaluate its psychometric properties, including internal structure, reliability, and convergent validity with the Mobile Phone Problem Use Scale-10, among nursing students in Greece. Methods: In a cross-sectional study, nursing students from multiple departments across Greece (N = 331) completed the Greek SAS-SV, distributed online via official university forums, student groups, and institutional social media pages, between September 2025 and November 2025. We conducted exploratory and confirmatory factor analyses using polychoric correlations, examined convergent validity, performed exploratory comparisons across demographic characteristics, and estimated the reliability of the SAS-SV. Results: Confirmatory factor analysis was consistent with a one-factor structure and showed acceptable model fit. Internal consistency was high (Cronbach’s α was 0.862 and McDonald’s omega was 0.891), with supportive evidence of convergent validity through its correlation with the MPPUS-10 (Spearman’s ρ = 0.772, p < 0.001). Conclusions: The Greek SAS-SV showed acceptable psychometric properties among nursing students and seems appropriate for research purposes in Greece. Full article

Adolescence constitutes a developmental stage marked by increased vulnerability to the adoption of consumption behaviors shaped by individual, social, and contextual determinants. This study aimed to examine the association between cumulative psychosocial vulnerability and the consumption of alcohol, coffee, and energy drinks among adolescents in Romania, employing a composite behavioral score designed to capture personal, social, and contextual stability. This cross-sectional study included 521 adolescents, with data collected during the COVID-19 pandemic when schooling was entirely online. Alcohol, coffee, and energy drink consumption were analyzed using Pearson correlations and binary logistic regressions. The composite behavioral score was constructed as the mean of standardized indicators, with higher values reflecting lower levels of psychosocial vulnerability. Results indicate that the composite behavioral score is negatively and significantly associated with alcohol consumption (r = −0.150, p = 0.001; OR = 0.51, 95% CI [0.33–0.80], p = 0.002), indicating a lower likelihood of consumption among adolescents with more stable psychosocial profiles. In contrast, the score was not significantly associated with coffee or energy drink consumption. Analyses also revealed significant differences in the composite behavioral score by gender (Cohen’s d = −0.82), with boys exhibiting higher vulnerability, and by residential environment (Cohen’s d = −1.15), with adolescents from rural areas—particularly boys—showing higher levels of psychosocial vulnerability. A secondary composite score, excluding demographic variables, was also computed to assess the robustness of the observed associations, with only area of residence remaining a significant predictor. In conclusion, the findings are consistent with the hypothesis that cumulative psychosocial vulnerability is relevant for explaining alcohol consumption in adolescence but not for coffee or energy drink use. These results highlight the need for a conceptual distinction between consumption behaviors with a normative status and those more clearly associated with psychosocial risk, as well as the importance of prevention interventions tailored to the specific characteristics of each type of consumption. Full article

Background: Severe, treatment-resistant Obsessive–Compulsive Disorder (OCD) remains a major clinical challenge. When conventional pharmacological and psychotherapeutic strategies fail, neuromodulatory interventions such as repetitive transcranial magnetic stimulation (rTMS) and psychosurgical approaches are increasingly considered. Although both modalities target nodes within the cortico-striato-thalamo-cortical (CSTC) circuit, their relative effectiveness has not been examined within a unified analytical framework. Objective: We aimed to compare responder rates between rTMS and psychosurgical interventions in adults with treatment-resistant OCD through a systematic review and meta-analysis. Methods: A PRISMA-guided search of PubMed and Scopus (2015–2025) identified clinical studies reporting treatment response. Pooled responder rates were estimated separately for each modality using random-effects models. Between-study heterogeneity and publication bias were systematically assessed. Results: Fourteen studies met inclusion criteria, including 10 rTMS studies (416 participants) and four lesion-based psychosurgical studies (142 participants). Both modalities demonstrated clinically meaningful responder rates. Pooled analyses suggested higher responder proportions in psychosurgical cohorts (RR = 3.06, 95% CI 1.43–6.54); however, this finding was accompanied by substantial heterogeneity (I² = 63%) and signals of publication bias. Follow-up duration differed markedly between modalities (mean 2.4 months for rTMS vs. 33.0 months for psychosurgery), reflecting fundamentally different study designs and outcome assessment timepoints. Conclusions: Differences in pooled responder rates should be interpreted as exploratory rather than as evidence of comparative efficacy. The lack of a shared comparator, differences in patient selection, and large discrepancies in follow-up limit direct comparisons between modalities. These findings support a stepped-care framework for neuromodulation in treatment-resistant OCD and highlight the need for methodologically harmonized studies to better define the role of each intervention across distinct clinical profiles of treatment resistance. Full article